Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Retinal vasculopathy with cerebral leukoencephalopathy carrying TREX1 mutation diagnosed by the intracranial calcification: a case report

Ryouhei Komaki, M.D.1)2), Takehiro Ueda, M.D., Ph.D.1), Yukio Tsuji, M.D.1), Toko Miyawaki, M.D.1), Sentaro Kusuhara, M.D., Ph.D.3), Shigeo Hara, M.D., Ph.D.4) and Tatsushi Toda, M.D., Ph.D.1)5)

1)Division of Neurology, Kobe University Graduate School of Medicine
2)Department of Neurology, Kita-Harima Medical Center
3)Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine
4)Department of Diagnostic Pathology, Kobe University Hospital
5)Department of Neurology, Graduate School of Medicine, The University of Tokyo

A 40-year-old woman with renal dysfunction for 2 years was admitted to our hospital suffering from a headache. Family history revealed that her mother had a headache, renal dysfunction, and brain infarction in younger age. She had a retinal hemorrhage, a retinal atrophy, pitting edema in her lower extremities. Her neurological findings were unremarkable. Brain imaging showed multiple white matter lesions accompanied with calcifications and slightly enhancement. Kidney biopsy showed the thrombotic microangiopathy, Gene analysis demonstrated a causative mutation in three-prime repair exonuclease-1 (TREX1) gene, c.703_704insG (p.Val235GlyfsX6), thereby we diagnosed her as retinal vasculopathy with cerebral leukoencephalopathy (RVCL). RVCL is an autosomal dominant condition caused by C-terminal frame-shift mutation in TREX1. TREX1 protein is a major 3' to 5' DNA exonuclease, which are important in DNA repair. While TREX1 mutations identified in Aicardi-Goutieres syndrome patients lead to a reduction of enzyme activity, it is suggested that mutations in RVCL alter an intracellular location of TREX1 protein. There are no treatments based evidences in RVCL. We administered cilostazol to protect endothelial function, and her brain lesions and renal function have not become worse for 10 months after. It is necessary to consider RVCL associated with TREX1 mutation if a patient has retinal lesions, white matter lesions accompanied with calcifications, and multiple organ dysfunction.
Full Text of this Article in Japanese PDF (1057K)

(CLINICA NEUROL, 58: 111－117, 2018)
key words: TREX1, RVCL, cerebral calcification, leukoencephalopathy

(Received: 4-Sep-17)